Indocyanine Green Fluorescence-Guided Enucleation via the Serosal Approach for Benign Subepithelial Tumors of the Gastroesophageal Junction

Ji-Hyeon Park, Sojung Kim, Ho Seok Seo, Kyo Young Song, Han Hong Lee

J Surg Innov Educ. 2025;2(2):31-34.   Published online December 19, 2025

DOI: https://doi.org/10.69474/jsie.2025.00283

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Subepithelial tumors (SETs) located at the gastroesophageal (GE) junction remain technically challenging in minimally invasive surgery because the convergence of the esophageal sphincter, diaphragmatic hiatus, and gastric fundus creates a confined operative field. When a tumor is fully embedded within the muscular layer, its capsular margin is often indistinguishable from the serosal surface, making precise enucleation technically demanding. To address this limitation, we adopted a fluorescence-guided technique that enables accurate intraoperative localization of the tumor through indocyanine green (ICG) injection. After induction of anesthesia, approximately 0.1–0.2 mL (0.05–0.1 mg) of ICG diluted in normal saline is injected endoscopically into the submucosal plane at the tumor site for benign SETs. During surgery, near-infrared visualization provides a distinct fluorescent margin that guides safe serosal incision and enucleation while preserving the mucosa and the anatomy of the GE junction. This technique is particularly useful for benign, well-encapsulated lesions such as leiomyoma or ectopic pancreas, where clear dissection planes can be preserved. However, it should not be used for lesions with any suspicion of gastrointestinal stromal tumor or other malignant potential, because capsular or intratumoral injection may pose a theoretical risk of tumor cell dissemination. Careful peritumoral submucosal injection that avoids capsular disruption may be cautiously considered. In selected benign tumors, ICG-guided serosal enucleation provides clear localization, facilitates complete resection, and minimizes both functional and structural complications at the GE junction.

Laparoscopic Extended Totally Extraperitoneal Hernia Repair with Posterior Component Separation with Transversus Abdominis Release for a Recurrent Incisional Hernia

Sa-Hong Kim, Kyoyoung Park, Chungyoon Kim, Jeesun Kim, Do-Joong Park, Hyuk-Joon Lee, Seong-Ho Kong

J Surg Innov Educ. 2025;2(1):5-8.   Published online June 17, 2025

DOI: https://doi.org/10.69474/jsie.2025.00024

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A patient with multiple comorbidities, including hypertension, type 2 diabetes, hyperlipidemia, and edema, and a prior history of abdominal surgery presented to the gastrointestinal department with a recurrent incisional hernia larger than 10 cm. The patient underwent laparoscopic extended totally extraperitoneal (e-TEP) hernia repair under general anesthesia. The bilateral retrorectal spaces were accessed via three trocars, followed by midline crossover in the upper abdomen and caudal dissection along the fascial defect. Due to the large size of the defect and the anticipated tension, posterior component separation (PCS) with transversus abdominis release (TAR) was performed, with careful preservation of the neurovascular bundles running anterior to the head of the transversus abdominis muscle. After separate closure of the posterior and anterior layers using barbed sutures, a mesh was placed in the intercomponent space to avoid direct contact with intraperitoneal structures. Closed-suction drains were placed bilaterally to prevent seroma formation. The procedure was completed successfully, and the patient experienced no complications. The patient was discharged without complications. A follow-up computed tomography scan demonstrated the integrity of the hernia repair, with progressive resolution of fat infiltration and fluid collection. Laparoscopic e-TEP hernia repair with PCS and TAR provides a safe and effective approach for managing complex recurrent incisional hernias. This technique enables tension-free closure with mesh placement while minimizing intra-abdominal complications.

A Practical Guide to Robotic Transabdominal Preperitoneal Repair for Inguinal Hernia

Sungwoo Jung, Hyung Soon Lee

J Surg Innov Educ. 2025;2(1):1-4.   Published online June 16, 2025

DOI: https://doi.org/10.69474/jsie.2025.00052

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Abstract PDF

Robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair offers enhanced visualization, ergonomic comfort, and improved instrument control compared to conventional laparoscopy. Although laparoscopic transabdominal preperitoneal repair has known benefits, its adoption remains limited due to technical challenges and a steep learning curve. The robotic platform addresses these limitations, making it well-suited for safe, precise dissection in the preperitoneal space. This article presents a practical, step-by-step guide to R-TAPP, highlighting key anatomical landmarks, standardized dissection techniques, and tension-free mesh placement without fixation.

Citations

Citations to this article as recorded by  

• Da Vinci Xi versus laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials
  Wajahat Mirza, Mehak Ejaz Khan, Hania Iqbal, Alishbah Khan, Hadi Mohammad Khan, Hamza Nasir Chatha, Eshan Ahmad, Sundus Dadan, Abdul Rafeh Awan, Muhammad Ahmad Nadeem
  Journal of Robotic Surgery.2025;[Epub]     CrossRef

Liver

Optimized Surgical Techniques in Laparoscopic Living-Donor Right Hemihepatectomy Using Indocyanine Green Fluorescence Images

YoungRok Choi, Suk Kyun Hong, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh

J Surg Innov Educ. 2024;1(1):14-17.   Published online June 26, 2024

DOI: https://doi.org/10.69474/jsie.2024.00066

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This paper outlines the surgical technique for laparoscopic living-donor right hemihepatectomy (LLDRH), a minimally invasive procedure that increases graft safety and reduces donor morbidity. The technique includes careful patient selection, precise port placement, meticulous liver mobilization, and careful parenchymal dissection, followed by secure graft extraction and effective hemostasis. LLDRH offers several advantages over open living-donor surgery, including lower costs, less postoperative pain, shorter hospital stays, and better cosmetic results. The use of advanced three-dimensional laparoscopic systems and indocyanine green fluorescence imaging has further increased the safety and effectiveness of this procedure. As laparoscopic technology continues to evolve, LLDRH is likely to become more widely adopted, offering a valuable option for liver transplantation programs. A video clip shows a 32-year-old woman with a body mass index of 25.7 kg/m2 who donated her right liver. Her remnant liver volume was 34%, and the estimated graft-to-recipient weight ratio was 1.2. The operation time was 240 minutes, with an estimated blood loss of 150 mL. She was discharged on the fifth postoperative day without any complications.

Thyroid

Single-Port Robotic Areolar Thyroidectomy: How I Do It

Myeong Ho Shin, Sun Min Lee, Hilal Ozer Hwang, Jin Wook Yi

J Surg Innov Educ. 2024;1(1):18-21.   Published online June 25, 2024

DOI: https://doi.org/10.69474/jsie.2024.00052

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Abstract PDFSupplementary Material

With the recent development of the da Vinci Single Port (SP) robotic surgical system, new surgical methods applying the da Vinci SP in thyroid surgery are being reported. We first reported a method known as single-port robotic areolar (SPRA) thyroidectomy in 2023, and we performed more than 100 SPRA thyroidectomies in a year. SPRA is a more minimally invasive method than the existing bilateral axillary breast approach method, as the subcutaneous flap area is reduced by more than 50%. Herein, we present a step-by-step description of the method of SPRA thyroidectomy.

Citations

Citations to this article as recorded by  

• Recent advances in single-port robotic thyroidectomy: evolution, techniques, and clinical outcomes
  Jin Kyong Kim, Dong Wook Kim, Jae Sang Ryu, Sungkeun Kang, Eun Jin Kim, Sang-Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung
  Annals of Surgical Treatment and Research.2026; 110(1): 3.     CrossRef